BURN

Dr Jeremy SpB

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• Papyrus (1500 SM)  Egypt, Resin dan Honey
• China (1600 SM)  Tea leaves extract
• Hipoccrates  Pig’s oil and resin for dressing
• Fabricius Hildanus (Germany, 1967)  Burn
patophysiology
• Dupuytren (Early 19th century)  Introduce
burn wound depth
– Also introduce gastric and duodenal ulcer as a
complication from burn wound.
• Trauma can be defined as bodily injury severe enough
to pose a threat to life, limbs, and tissues and organs,
which requires the immediate intervention of
specialized teams to provide adequate outcomes.
• Burn injury, unlike other traumas, can be quantified
as to the exact percentage of body injured, and can be
viewed as a paradigm of injury from which many
lessons can be learned about critical illness involving
multiple organ systems.
1. Early/ Acute/ Shock Phase
Dehydration, electrolyte imbalance due to systemic
burn injury, perfusion problem

2. Subacute Phase
Lost of normal tissue, infection prone,
hypermetabolism, wound care problem

3. Late Phase
Scarring problems, hypertrophic scar,
contracture
 Classification of Burn Injuries

Etiology :
Fire

Scald

Chemical

Electric

Radiation

frost bite
 Classification of Burn Injuries

Burn Depth :

First Degree
Depends on
Second Degree the etiology
and exposure
Third Degree time
Zones of Tissue Injury Following
Burns

Zone of Coagulation
• The most severely burn portion, typically in the center
• The affected tissue is coagulated and sometimes necrotic

Zone of Stasis
• Has a local response of vasoconstriction and resultant
ischemia.

Zone of Hyperemia
• will heal with minimal or no scarring.
Classification of Burn Injuries
 Burn Percentage

• Rule of nine
• Lund & Browder Chart
• Patient’s palm (1%)
 Treatment

•
 Guideline for Referral to a Burn Center

• Second and third degree burns >10% body

surface area (BSA) in patients <10 or >50 years
old.
• Second and third degree burns >20% BSA in
other groups.
• Second and third degree burns with serious
threat of functional or cosmetic impairment
that involve face, hands, feet, genitalia,
perineum, and major joints.
• Third degree burns >5% BSA in any age group.
• Electrical burns, including lightening injury.
 Guideline for Referral to a Burn Center
• Circumferential burns with burn injury.
• Burn injury in patients with pre-existing medical
disorders that could complicate management,
prolong recovery, or affect mortality.
• Any burn patient with concomitant trauma (for
example fractures) in which the burn injury
poses the greatest risk of morbidity or mortality.
• Hospitals without qualified personnel or
equipment for the care of children should
transfer burned children to a burn center with
 Treatment

Patient assessment :
 Primary assessment

• Identify life threatening condition

• Airway :
– Oxygenation,
– Observe for any obstruction : progressive
hoarseness, Stridor, Wheezing, Carbonaceous
sputum production, Burn in the face and neck
 immediate Intubation
• Breathing
Respiratory rate, chest expansion  any
circumferential wound?  escharotomy
 Primary assessment

• Circulation
Heart Rate, Blood Pressure, Urine
Production
• C-spine immobilization
Blast injury or Traffic accident
 Secondary assessment

• A thourough head-to-toe evaluation

Trauma history, mechanism, closed
chamber, chemical gas, inhalation, etc

• Other Trauma
 Wound Evaluation

• Temporarily clean the wound

• Determine burn depth and percentage
• Extremity : distal pulsation (Circumferential
burn) Escharotomy?
• Wide Debridement  General Anesthesia
• Never administer prophylactic antibiotics
other than tetanus vaccination.
 Fluid Resuscitation

- Use rational medication

- Adequate fluid resuscitation (Crystalloid,
Colloid)
- Determine burn percentage
- Determine patient’s bady weight
- Vital organ information : Kidney, lungs,
heart, liver
 Resusitasi cairan

• Formula resusitasi cairan bukan suatu patokan

mutlak !! monitoring klinis dari waktu ke
waktu lebih penting.

• 1. Formula Evans-Brooke
1(0,5) ml/kgBB/%LB darah (koloid)
1 (1,5) ml/kgBB/%LB saline(elektrolit)
2000 ml glukosa
Monitoring : diuresis (>50 (30-50) ml/jam)
CVP (>+2)
Hb - Ht
  Resusitasi cairan

• 2. Formula Baxter (Parkland)

4 ml/kgBB/%LB
½ diberikan 8 jam pertama sejak cedera,
berikutnya dalam 16 jam
ringer lactate/asetat
Monitoring :
diuresis 50 – 100 ml/jam, CVP (>+2 ), Hb-Ht
  Monitoring

• Patokan klinis :

 gbran sirkulasi perifer, cukup/tidaknya cairan

 1 ml/kgBB/jam
 myo/hemoglobinuria : + bicnat ke IV fluid utk
alkalinisasi urin, diuresis 1 – 2 ml/kgBB/jam. Bila
perlu beri manitol
 Monitoring

 gbran fs paru scr langsung & sirkulasi scr tdk

langsung, tp dipengaruhi oleh faktor lain spt nyeri,
obat depresan nafas,dsb

 gbran hemokonsentrasi krn vasokonstriksi dan

hipovolemi
informasi vol cairan dlm sirkulasi
Lain-lain : dekompresi lambung,lab.,dll
 Complication in Burn Care

• Pneumonia due to prolonged ventilation

• Massive resuscitation  abdominal
compartment syndrome
– Increased airway pressure with hypoventilation
– Decreased urine output
– Hemodynamic compromise
• DVT (rare)
• Tetanus
 Refferences

• Schwartz Principles of Surgery 9th edition

• Grabb and Smith Plastic Surgery
Learning Objective
Reference